Overview of Program Content and Overall Educational Goals
The Gastroenterology Fellowship Training Program at Strong Memorial Hospital, University of Rochester Medical Center, is an accredited 3-year program. Three fellows are accepted per year.
Clinical education is provided throughout the 3-year curriculum, with a dedicated block of protected research experience provided in the second year. Clinics, including fellow’s long-term continuity clinic, and call are maintained throughout the 3-year curriculum.
The program is structured to provide a gradual advancement in the depth and complexity of education and responsibility.
In year I, each first year fellow will spend 7 months on Consult Service (during which they do inpatient consults and procedures), 4 1/2 months of protected endoscopy rotation to facilitate endoscopic skills, and two weeks of motility elective for a hands-on motility experience and 2 week research elective for training, brainstorming and mentoring. By the end of the first year, the fellows have been able to meet the requirements for competency in the basic endoscopic core procedures of Gastroenterology. All fellows participate in one half-day clinic session with the same attending preceptor for 6-12 months, before rotating with another faculty member. In addition, there is a (faculty supervised) fellow’s long-term continuity clinic which provides a panel of patients for whom the fellow is the principal (consultant) care provider for 3 years. First year fellows participate in supervising the medical residents and students rotating on their Gastroenterology elective. They rotate responsibility with the other fellows in preparing didactic conferences which include weekly case-based clinical topic conference, and monthly basic science conference.
For the weekly clinical conference, they are assigned to the more basic clinical topics. They select cases for review in Pathology joint conferences, and they present literature reviews at monthly Journal Club. A GI-Board Review Conference Series is also held, which helps provide an overview of the entire specialty to the first year fellows. Research conference and Morbidity and Mortality conference are held monthly. Evening and weekend calls are shared in rotation with the other fellows. First-year fellows are mentored by clinical faculty in preparing clinical abstracts for submission in June (end of first year) to the American College of Gastroenterology, and if accepted for presentation, the fellow is sponsored to travel to the scientific meeting to present his/her poster. All first-year fellows participate in the Fellowship Steering Committee.
In year II, approximately 6 months are set aside for the fellow to participate in a dedicated QI, research and scholarly projects, and 6 months are set aside for participation in a Transplant Hepatology rotation. The Transplant Hepatology rotation is a saturated rotation split between both dedicated outpatient and inpatient experiences in pre- and post-liver transplant assessment and management, working directly with our Transplant Hepatology attendings and the multi-disciplinary Transplant Surgery Team. This includes evaluation and management of new and follow-up inpatient and outpatient liver transplant referrals and participation in transplant selection committee. Fellows also participate in a two week nutrition support elective with online and in-person clinical nutrition training with URMC nutrition specialists and support staff. Second-year fellows also share responsibilities interpreting video capsule endoscopy throughout the year, under supervision by select attending faculty members. During year II, educational activities, call duties, and clinic duties continue. The fellows continue to participate in an attending preceptor’s clinic one half-day session per week, and continue their weekly long-term continuity clinic.
Second-year fellows are expected to begin developing and participating in at least one quality improvement project and one academic scholarly project. Fellows will identify mentors with similar interests and work throughout fellowship to develop and execute scholarly pursuits. A robust research support team is available, including a divisional research coordinator and support available through the University. The second-year fellow is sponsored to attend the annual national Digestive Disease Week conference held in May, which is an extensive scientific session on clinical and bench research in Gastroenterology and Hepatology, sponsored by the major professional societies in these disciplines. The fellow will also be sponsored to attend any additional scientific meetings to which he/she has had a paper accepted for presentation.
The second-year fellows take on a major leadership and educational role related to the divisions’ robust academic conferences. They continue to participate in didactic conference presentations, most often being assigned to the more clinically integrated topics. They continue to present critical reviews of the scientific literature at Journal Club, and continue to attend Morbidity and Mortality conference, Morning Report, GI-Pathology Conference, the GI Board Review Conference Series, Basic Science Conferences, and one of the second-year fellows chosen by their peers is selected to participate in the Fellowship Steering Committee. Evening and weekend calls are shared in rotation with the other fellows.
In year III, the fellows rotate as Chief Fellow. In the second half of the year, they each spend one month returning to the inpatient Consult service experience as an “Acting Attending”. During this experience, they are expected to exercise a greater range and depth of directing independent patient care assessment and management. While they are still supervised, they are nonetheless being assessed for their preparedness to assume the independent practice of this consultative subspecialty. The remainder of the third year is devoted to endoscopy, including advanced procedures and techniques, and two months of structured elective time is encouraged. These electives ideally allow the fellow to uniquely enhance and develop competencies in a manner that enriches their clinical training. All senior fellows receive training in the techniques and interpretation of Motility studies. During year III, educational activities, call duties, and clinic duties continue.
Senior fellows spend time enhancing general therapeutic skills performing endoscopy on inpatients under supervision of the consult attending. Also there is a dedicated endo-colon rotation to enhance outpatient basic colonoscopy skills in anticipation for independent practice. The senior fellows participate in an attending preceptor’s clinic one half-day session per week, and continue their long-term continuity clinic exposure. They continue to participate in didactic conference presentations, and are now being assigned to more focused and controversial topics for review. They continue to present critical reviews of the scientific literature at Journal Club, and continue to participate in GI-Pathology Conference, Basic Science Conferences, the GI Board Review Conference Series, Morbidity and Mortality conference, and one of the third-year fellows chosen by their peers is selected to participate in the Fellowship Steering Committee. Evening and weekend calls are shared in rotation with the other fellows. Third year fellows are sponsored to attend national meeting if they are making a presentation. Chief Fellows are involved in formal review of program evaluations, teaching participation of second year medical students in the Disease Processes and Therapeutics course of the medical school, participation in committee work such as peer selected representation to Internal Review of other residency programs, and organize and coordinate the fellow call schedules and conference schedules.
With respect to advanced procedures (particularly ERCP and EUS), the issue is now specifically addressed at a national level by the core curriculum in Gastroenterology. The core curriculum was constructed by the AGA, the ASGE, the AASLD, and ACG (our professional colleges), and adopted for implementation by the American Board of Medicine and the ACGME effective July 1, 2005 pertinent to the issues of training in advanced endoscopic procedures. In essence, the curriculum states that training in ERCP or EUS is not part of the core training during GI fellowship, but exposure in these procedures may be available to trainees. We reserve the right to subjectively identify which trainee, if any, possesses sufficient skill to be considered for full training in such a procedure, with the intention to credential the trainee in that procedure if they demonstrate sufficient competence. This specifically means that not every fellow will be trained to a level of competence in ERCP and/or EUS.
The specific educational goals of the clinical and research activities and the specific division policies on a variety of issues are presented throughout the curriculum.
Overall Educational Goals for the Program
The main goal of the Fellowship Program in Gastroenterology is to provide Internal Medicine specialists with subspecialty training in the fields of digestive and liver diseases, allowing competence to be achieved in the requisite knowledge base, critical thinking skills, procedural skills, humanistic and ethical skills encompassed by these fields.
In a carefully structured and supervised setting, trainees are exposed to clinical and procedural activities designed to gradually increase in complexity while they gradually decrease in the level of directed supervision. These activities are supplemented with a comprehensive program curriculum of continuous didactic review, clinical teaching sessions, literature review, quality improvement meetings and various other programs designed to enhance and address training and awareness of the humanistic and professional issues in our field.
Trainees are provided structured opportunities to develop teaching skills at a variety of levels. Additionally, trainees participate in scientific research as a means of promoting the development of the investigative and inquisitive critical thinking skills required of subspecialty consultants in order to generate new knowledge and improve patient care.
Our program prides itself on having the resources and flexibility to tailor an individualized learning plan for the development of the trainee’s career interests beyond the core requirements.